Clinical Engineering Benchmarking Comparison Between Zhejiang Province and American Hospitals

Clinical engineering(CE) has evolved rapidly over the last 25 years in China. Among the 34 provincial-level administrative units within China, the Zhejiang Province is one of the most advanced in terms of healthcare technology maintenance and management. In order to determine Zhejiang's current stage of development and opportunities for further improvement, a comparison of the performance of its CE departments was made against hospitals in the USA. Data were collected from 21 Zhejiang hospitals and compared to those from 270 acute-care hospitals in USA collected by Truven Health Analytics. The benchmarking comparison was made in three categories: operational, financial, and productivity. Within the operational category, the following metrics were compared: equipment inventory size/operating beds, annual repairs/inventory size, and annual scheduled maintenance/inventory size. Within the Financial category, the following metrics were compared: total CE expense/operating beds and total CE expense/total hospital expense. Within the Productivity category, the following metrics were compared: total CE full-time equivalent(FTE)/inventory size and total CE FTE/total hospital expense. These comparisons showed that:(1) While the equipment inventory in Zhejiang tends to be much smaller than USA for hospitals of comparable amount of operating beds, the numbers of repairs and scheduled maintenance per inventory size are similar;(2) The total CE expense/total hospital expense ratio is around 1% in both Zhejiang and USA; however, the total CE expense/operating beds and total CE expense/cost of equipment inventory are significantly lower in Zhejiang than USA;(3) The FTE amount in Zhejiang is significantly higher than in USA relative to both inventory size and total hospital operating expense, but significantly lower relative to the number of operating beds. The fact that repairs and scheduled maintenance are similar in Zhejiang and USA shows that CE leaders are managing equipment in comparable manner. Most of the differences found in the comparisons were traced to a few factors. First, the average length of stay in China is substantially higher than USA, which explains why hospitals in Zhejiang tend to have more operating beds but fewer pieces of equipment. Second, labor cost is significantly lower in China than USA, thus allowing Zhejiang hospitals to employ more workers than their American counterparts. Third, there is significantly difference in the cost of living between China and USA; Finally, being public entities Chinese hospitals are managed and operated in a different manner than American hospitals, which are mostly private, albeit nonprofit organizations. Nonetheless, it is interesting to note that hospitals in both areas spend roughly 1% of their total expenditure for CE. The results suggest that CE in Zhejiang is comparable to USA in terms of managerial excellence but there could be some room for improvement in financial management and productivity.

Introduction of Education Systems for Clinical Engineers in Japan

Japanese clinical engineer(CE) is a significant and unique profession compared with other nations with its dual clinical and technology focus and national licensing. The CE system of licensing was established in May 1987 under the Clinical Engineers Act. CEs are required to complete 3 to 4 years in designated schools and pass a national examination. It is a professional medical position responsible for the operation and maintenance of life-support and non-life-support medical device systems under the direction of physicians. Currently approximately 70 educational institutes- including technical colleges and universities- provide diverse and wide-ranging curricula from engineering to various clinical disciplines to produce CEs. Since clinical practice training is mandatory as a part of institute work, an important approach for CEs is gained by working in hospitals. The comprehensive curricula and the licensing system in Japan together serve to keep the appropriate quantity and quality of CEs. The Japan Association for Clinical Engineers(JACE) was established in February 1990; one of its aims is to support improvement of CEs throughout their careers through various lectures, seminars, on-the-job trainings, workshops, and an annual member meeting. New CEs can now take advantage of video e-learning. For junior CEs, there are seminars for hyperbaric oxygen therapy, blood purification, heart-lung bypass, respiratory therapy, operating room, intensive care unit, arrhythmia and aphaeresis related devices, as well as healthcare technology management(HTM). Also, the institutes provide a leadership seminar alongside this clinical practice training. Besides the licensing process, a proper certification system for CEs is a critical element in the clinical field. This enhances the ability of CEs to engage in more extensive duties and develop specialties, as well as to provide better healthcare. Associated societies provide certification with technology qualifications in dialysis, extracorporeal circulation, respiratory therapy, clinical medical devices, hyperbaric oxygen therapy, and aphaeresis treatment. JACE also launched a unique certification system in 2010, with specializations in blood purification, arrhythmia, respiratory, and hyperbaric oxygen care. What is the difference between certification by the associated societies and that offered by JACE? Certification by the associated societies provides basic knowledge to pass specialty examinations. Certifications by JACE promote deeper knowledge to enhance clinical decisionmaking and to encourage wider experience. JACE also continues to investigate other certifications. In summary, Japan has introduced a national licensing system for keeping an intake of constant quality and quantity of CEs. Additionally, ongoing workshops and seminars stimulate in-depth knowledge and a higher level of medical care for patients. Together, a system of lifelong education for CEs has been built.

Design of a Web-based Medical Equipment Management System for Clinical Engineering

Objective: Medical equipment safety in clinical use has been an increasingly concerned issue in China. This paper aims to design and implement a web-based medical equipment maintenance system to be used at clinical engineering department, orienting to the improvement of quality and efficiency of technology service so as to meet the 2010 regulations homologated with China's Ministry of Health. Methods: The system adopted three-layer structure based on B/S mode with oracle database and ASP.NET development technologies. Based on risk management and inclusion criteria for maintenance, the software system modules consist of hospital equipment inventory management, personnel information management, breakdown maintenance, preventive maintenance(PM) and analysis graphical representations.Results: An user friendly web interface was provided for easy and secure access to the system. Medical equipment management activities from log-in to acceptance test to maintenance services were implemented. Conclusion: The application of this system has achieved benefits for the risk management of medical equipment.

Clinical significance of provoked coronary spasm at chronic stage in patients who underwent successful complete coronary revascularization with first-generation drug-eluting stents

Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusTM) implantation and had no residual stenosis at follow-up coronary angiography were included. All patients also underwent acetylcholine provocation test (ACh) at follow-up angiography. Age, sex, coronary risk factors (smoking, hypertension, diabetes mellitus, dyslipidemia), medication (calcium channel blockers, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, nitrates, β blockers, statins), duration from stent implantation to follow-up angiography (15.5 ± 14.5 months), old myocardial infarction, Ach + were included as variables for multivariate analysis for cardiovascular events (angina pectoris without intervention, target lesion revascularization, acute myocardial infarction, definite or probable stent thrombosis, cardiac death, and stroke). ACh provocation test was positive in 64.8%. The following events occurred during a mean follow-up period of 26.9 ± 9.5 months;angina pectoris without intervention in 12, very late stent thrombosis in 1, acute myocardial infarction in 1, sudden death in 1, and stroke in 4. By Adjusted Cox hazard model, age was the independent predictor of future cardiovascular events. ACh was unbalanced data for Cox hazard model, and by logistic regression model, ACh was the strongest predictor. Conclusions: Coronary endothelial dysfunction at chronic stage is the strongest predictor of further prognosis in patients with first-generation DES.

Current applications of artificial intelligence-based computer vision in laparoscopic surgery

Recent advances in artificial intelligence(AI)have sparked a surge in the application of computer vision(CV)in surgical video analysis.Laparoscopic surgery produces a large number of surgical videos,which provides a new opportunity for improving of CV technology in laparoscopic surgery.AI-based CV techniques may leverage these surgical video data to develop real-time automated decision support tools and surgeon training systems,which shows a new direction in dealing with the shortcomings of laparoscopic surgery.The effectiveness of CV applications in surgical procedures is still under early evaluation,so it is necessary to discuss challenges and obstacles.The review introduced the commonly used deep learning algorithms in CV and described their usage in detail in four application scenes,including phase recognition,anatomy detection,instrument detection and action recognition in laparoscopic surgery.The currently described applications of CV in laparoscopic surgery are limited.Most of the current research focuses on the identification of workflow and anatomical structure,while the identification of instruments and surgical actions is still awaiting further breakthroughs.Future research on the use of CV in laparoscopic surgery should focus on applications in more scenarios,such as surgeon skill assessment and the development of more efficient models.

Chinese expert consensus on laparoscopic hepatic segmentectomy and subsegmentectomy navigated by augmented-and mixed-reality technology combined with indocyanine green fluorescence imaging

Augmented-and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries.Indocyanine green fluorescence imaging technology has enabled anatomical,functional,and radical hepatectomy through tumor identification and localization of target hepatic segments,driving a transformative shift in themanagement of hepatic surgical diseases,moving away from traditional,empirical diagnostic and treatment approaches toward digital,intelligent ones.The Hepatic Surgery Group of the Surgery Branch of the Chinese Medical Association,Digital Medicine Branch of the Chinese Medical Association,Digital Intelligent Surgery Committee of the Chinese Society of ResearchHospitals,and Liver Cancer Committee of the Chinese Medical Doctor Association organized the relevant experts in China to formulate this consensus.This consensus provides a comprehensive outline of the principles,advantages,processes,and key considerations associated with the application of augmented reality and mixed-reality technology combined with indocyanine green fluorescence imaging technology for hepatic segmental and subsegmental resection.The purpose is to streamline and standardize the application of these technologies.

Prediction of SMILE surgical cutting formula based on back propagation neural network

AIM:To predict cutting formula of small incision lenticule extraction(SMILE)surgery and assist clinicians in identifying candidates by deep learning of back propagation(BP)neural network.METHODS:A prediction program was developed by a BP neural network.There were 13188 pieces of data selected as training validation.Another 840 eye samples from 425 patients were recruited for reverse verification of training results.Precision of prediction by BP neural network and lenticule thickness error between machine learning and the actual lenticule thickness in the patient data were measured.RESULTS:After training 2313 epochs,the predictive SMILE cutting formula BP neural network models performed best.The values of mean squared error and gradient are 0.248 and 4.23,respectively.The scatterplot with linear regression analysis showed that the regression coefficient in all samples is 0.99994.The final error accuracy of the BP neural network is-0.003791±0.4221102μm.CONCLUSION:With the help of the BP neural network,the program can calculate the lenticule thickness and residual stromal thickness of SMILE surgery accurately.Combined with corneal parameters and refraction of patients,the program can intelligently and conveniently integrate medical information to identify candidates for SMILE surgery.

Functional oesophago-gastric junction imaging

尽管有它在疾病的角色，仍然没有权威的方法估计 oesophago 胃的连接胜任(OGJ ) 。传统地， OGJ 作为指示物与更低的食道的括约肌压力用测压法被估计了。更最近，这被显示了不对倒流是括约肌功能和胜任的一个很可靠的标记。混乱象胃食道的倒流疾病那样并且到更小的 extend 弛缓不能仍然完成病人的一个重要数字。这评论看使用作为阻抗测面积池知道在一只袋子的扩张期间在 OGJ 介绍几何学和压力的一种新技术。收集的数据能被重建进 OGJ 行动的一个动态代表。这被显示了提供 OGJ 的一个有用代表并且由于 endoluminal 治疗以依从和膨胀性显示出变化到 OGJ 的胜任。

Heart-on-chips screening based on photonic crystals

Recently,organ-on-chips have become a fast-growing research field with the widespread development of microfluidic chips and synthetic materials in tissue engineering.Due to the existing cardiotoxicity of many cardiovascular drugs,heart-onchips which are promising to replace traditional animal models have been extensively researched and developed to mimic human organ functions in vitro.The heart-on-chips mainly focus on cardiac mechanics,which is regarded as the central indicator of in vitro heart models and drug testing.Traditional methods for the detection of myocardial mechanics have been demonstrated complex and inefficient in heart-on-chips.Therefore,photonic crystal materials with unique optical properties have attracted interests and have been introduced into the heart-on-chips,developing a visualized self-reporting system for cardiomyocytes activity monitoring.In this review,photonic crystal-based heart-on-chips for biosensing are introduced,as well as the fabricationmethods and design criteria of them.The characterizations of the photonic crystal materials are classified into optical properties and structural properties,and their applications in cell culture and biosensing are further discussed.Then,several representative examples and developments of the integration of photonic crystal materials into microfluidic chips are described in detail.Finally,potentials and limitations are put forward to promote the development of the photonic crystal-based intelligent heart-on-chips.

Computation of flow through the oesophagogastric junction

Whilst methods exist to indirectly measure the effects of increased flow or gastro-oesophageal refluxing, they cannot quantitatively measure the amount of acid travelling back up into the oesophagus during reflux, nor can they indicate the flow rate through the oesophagogastric junction (OGJ). Since OGJ dysfunction affects flow it seems most appropriate to describe the geometry of the OGJ and its effect on the flow. A device known as the functional lumen imaging probe (FLIP) has been shown to reliably measure the geometry of and pressure changes in the OGJ. FLIP cannot directly measure flow but the data gathered from the probe can be used to model flow through the junction by using computational flow dynamics (CFD). CFD uses a set of equations known as the Navier-Stokes equations to predict flow patterns and is a technique widely used in engineering. These equations are complex and require appropriate assumptions to provide simplifications before useful data can be obtained. With the assumption that the cross-sectional areas obtained via FLIP are circular, the radii of these circles can be obtained. A cubic interpolation scheme can then be applied to give a high-resolution geometry for the OGJ. In the case of modelling a reflux scenario, it can be seen that at the narrowest section a jet of fluid squirts into the oesophagus at a higher velocity than the fluid surrounding it. This jet has a maximum velocity of almost 2 ms-1 that occurs where the OGJ is at its narrowest. This simple prediction of acid ‘squirting’ into the oesophagusillustrates how the use of numerical methods can be used to develop a better understanding of the OGJ. This initial work using CFD shows some considerable promise for the future.

A New Approach: Chronotherapy in Acute Blood Purification for Septic Shock

Circadian rhythms are daily oscillations of multiple biological processes. Recently, relationships between circadian rhythms and immune functions have also been described. In a mouse sepsis model, the death rate due to lipopolysaccharide (LPS)-induced endotoxic shock was found to be dependent on LPS administration as determined by circadian time. In humans, a pronounced inflammatory response to endotoxemia differs depending on whether it is daytime or night-time: Levels of tumor necrosis factor-alpha and interleukin-6 were higher during the night. Therefore, it is reasonable to assume that circadian rhythms influence not only organ dysfunction and the prognosis induced by LPS, but also the therapeutic effect of anti-LPS therapy such as Polymyxin-B direct hemoperfusion. We herein postulate the concept that it is important to discuss septic shock treatment in terms of whether or not the treatment is adjusted for the optimal time window as determined by circadian rhythms.

Do we really understand the role of the oesophagogastric junction in disease?

The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.

Heart and skeletal muscle insulin resistance but not myocardial blood flow reserve could be related to chronic use of thiazolidione in patients with type-2 diabetes

Heart and skeletal muscle insulin resistance and abnormal myocardial flow reserve (MFR) occurs in patients with type-II diabetes. Improvement of heart and skeletal muscle insulin resistance with rosiglitazone use over 16 weeks have been reported. However, it is not clear whether chronic use of troglitazone can improve heart and skeletal muscle insulin resistance and MFR. Materials and Methods: To test the hypothesis whether effects of troglitazone on heart and skeletal muscle insulin resistance and MFR in patients with type-II diabetes, rest and dipyridamole stress perfusion positron emission tomography (PET) with 13N-ammonia and heart and skeletal muscle 18FDG PET scans under insulin clamping were undertaken before and 12 month after the initiation of troglitazone therapy (400 mg/day) in 23 patients with type-II diabetes. Twenty patients with type-II diabetes without CAD and without medications were served as controls. In controls, any medications were not added from the first PET study and 12 months after the second PET study. Results: Baseline myocardial blood flow (MBF) was comparable before and after the troglitazone group as was the controls. MBF during dipyridamole administration (0.56 mg/min/kg) was not significantly improved in troglitazone group and controls. MFR was not improved in troglitazone group and controls. In troglitazone group, whole body glucose disposal rate (GDR;μmole/min/kg) significantly improved (pre;19.0 ± 9.55, post;28.7 ± 15.3, p as did the skeletal muscle glucose utilization rate (SMGU (μmole/min/kg);pre;20.3 ± 12.0, post;34.8 ± 10.6, p insulin resistance is implicated in patients with type-II diabetes and impaired MFR is uncoupled with insulin resistance in the whole body and heart and skeletal muscle in patients with type-II diabetes.

如何保护和清洁镜面

很多眼科设备都有光学元件,如透镜、反射镜、滤光片和棱镜即使很小的损伤（如擦伤）都可以引起光散射,导致成像质量下降。透镜和棱镜的表面常涂有一层抗反射层,防止光的反射损失。反射镜表面涂有一层高反射膜,以保证最大程度的光反射。滤光片过滤不需要波长的光。

Appropriate Heart Rate in a Patient with Repaired Tetralogy of Fallot

Appropriate heart rate in a failing pulmonary ventricle remains unknown, particularly in congenital heart diseasewith unique hemodynamics. A 71-year-old male with repaired tetralogy of Fallot and a pacemaker for a sinusnode dysfunction suffered from heart failure symptoms with preserved left ventricular function. Simply changingthe pacemaker’s lower rate from 60 to 75 bpm, New York Heart Association classification improved from III to II,and hemodynamic parameters drastically improved. We regarded this case as informative. Appropriate heart ratecould be higher in congenital patients with failing right and non-failing left ventricles than in adults with malfunctioningLV.

CT Output Dose Performance-Conventional Approach versus the Dose Equilibrium Method

Current output dose measurement in CT is based on (CTDI). The conventional methodology of CT dosimetric performance characterization is not appropriate to modern CT scanners with helical scanning modes, dose modulation, array detectors and multiple slice planes or cone-beam irradiation geometries. AAPM TG 111 report recognizes the shortfall of the CTDI methods and recommends a new technique that more accurately characterizes the dose profile from modern CT scanners, which utilizes a short conventional ion chamber rather than a pencil chamber. We developed and characterize a in-house phantom design using a three separate anatomical regions of clinical scan sequences (Head, chest and abdomen), and determined the equilibrium dose in our dose equilibrium phantom, measured if the attenuation of the beam is the equal to that of CTDI Perspex phantom and compare CTDI dose estimations using a standard pencil chamber to the dose equilibrium phantom measurements. This methodology allows measurements of the accumulated dose for any clinical scan length and allowing measurement of the equilibrium dose. Using the new methodology, we determined that the CTDI approach can underestimate the dose by 25% to 35% and all of our dose values from the water phantom and farmer chamber were independently verified with TLD measurements.

End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy:A case report

BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.

Functional imaging of skeletal muscle glucose metabolism by ¹⁸FDG PET to characterize insulin resistance in patients at high risk for coronary artery disease

Insulin resistance is associated with several coronary risk factors and is thought to play a critical role for the development of coronary artery disease. Insulin resistance has several causes, including an impaired skeletal muscle glucose utilization rate (SMGU), reduced peripheral blood flow, and altered fatty tissue metabolism, with SMGU being considered the most important. Nonetheless, insulin resistance has only been estimated by the glucose disposal rate (GDR) in previous studies. Methods: Skeletal muscle metabolic imaging with 18FDG and positron emission tomography (PET) was undertaken to measure SMGU during hyperinsulinemiceuglycemic clamping in 22 normotensive type-2 diabetics under no medications (T2- DM), 17 normotensive non-diabetic hypertriglyceridemics, 22 patients with hypertension, and 12 agematched controls. Whole body insulin resistance was assessed by the GDR during hyperinsulinemiceuglycemic insulin clamping. Results: The SMGU and GDR were significantly reduced in T2DM (32.1 ± 16.6 μmol/min/kg and 24.3 ± 13.0 μmol/min/kg, respectively), hypertriglyceridemics (36.5 ± 13.5 μmol/min/ kg and 22.7 ± 8.07 μmol/min/kg respectively) and patients with hypertension (35.4 ± 26.6 μmol/min/kg and 29.0 ± 9.90 μmol/min/kg, respectively) compared with controls (72.2 ± 44.1 μmol/min/kg and 43.0 ± 22.9 μmol/min/kg, p < 0.01, respectively). In all groups studied, SMGU was significantly correlated with GDR (r = 0.76, p < 0.01) and GDR (F = 13.9) was independently related to SMGU (r = 0.81, p < 0.01). Conclusion: Insulin resistance is significantly associated with SMGU to a similar degree among patients with T2DM, essential hypertension and hypertriglyceridemia. 18FDG PET functional imaging allows insulin resistance to be assessed.

Measurement of lumbar muscle glucose utilization rate can be as useful in estimating skeletal muscle insulin resistance as that of thigh muscle

Background: Skeletal muscle glucose utilization (SMGU) can be accessed by positron emission tomography (PET) and18F-FDG to characterize insulin resistance. The quantity of skeletal muscle in the lumbar is sufficient to indicate that SMGU in the lumbar (SMGU- lumbar) can be measured with18F-FDG PET of the chest instead of obtaining thigh muscle SMGU (SMGU-thigh). This would reduce PET scan time to avoid thigh muscle PET scan. This study was aimed to compare SMGU-lumbar and thigh muscle SMGU under insulin clamping to identify the validity of measurements of SMGU in the lumbar for studies of insulin resistance. Methods: Thirty-three patients underwent sequential dynamic18F-FDG PET of both the thoracic (37 min) and thigh region (22 min) during hyperinsulinemic euglycemic insulin clamping. Both SMGU-lumbar and SMGU-thigh were calculated by Patlak graphical analysis. Whole body insulin resistance was assessed by a whole body glucose disposal rate during hyperinsulinemic euglycemic insulin clamping. Input function was obtained from the time activity curve of the descending aorta and venous blood sampling as previously validated. Results: SMGU-thigh (0.0506 ± 0.0334 μmol/min/g) was comparable to SMGU-lumbar (0.0497 ± 0.0255 μmol/min/g). The Bland-Altman method of difference plot analysis showed a significant correlationship between SMGU- thigh and SMGU-lumbar (r = 0.506, p = 0.0028). There were seen very good significant correlationship between whole body glucose utilization rate in both thigh (r = 0.737, p = 0.0001) and lumbar (r = 0.772, p = 0.0001). Conclusion: These results support the validity of measuring SMGU-lumbar to estimate insulin resistance during PET imaging of the chest.

Skeletal muscle and whole body insulin resistance but not cardiac muscle insulin resistance could be improved by troglitazone therapy within 12 weeks in type-2 diabetes

Background: Existence of myocardial insulin resistance (IR) has been reported in type II diabetics (T2- DM) and coronary artery disease (CAD). Improvement in heart and skeletal muscle IR after thiazolidinedione’s therapy was reported in T2DM and CAD. However effects of troglitazone therapy (TRO) on myocardial IR remain uncertain. To clarify heart and skeletal muscle and whole body IR in T2DM without CAD by TRO to clarify whether TRO would provide different results. Methods: We analyzed data on 15 T2DM patients who underwent dynamic PET with 18F-FDG under insulin clamping before and during TRO (200 mg/day) and 17 controls. Results: Whole body glucose disposal rate (WBGR mg/min/kg) in T2DM before TRO (3.41 ± 1.72) was significantly lower than in controls (9.76 ± 2.97, p < 0.01) as was the skeletal muscle glucose utilization rate (SMGU mg/min/kg);T2DM (0.367 ± 0.217) vs. controls (1.34 ± 0.613, p < 0.01) and myocardial glucose utilization rate (MGU mg/min/kg;T2DM 5.86 ± 2.03 vs. controls 7.34 ± 1.80, p < 0.05). WBGR in T2DM during TRO (5.17 ± 2.75, p < 0.05) was significantly higher than that before TRO, as was the SMGU (0.782 ± 0.20, p < 0.05). The MGU in T2DM during TRO (6.59 ± 0.72) was comparable with that before TRO. Conclusion: Myocardial IR response to TRO differed from that in skeletal muscle and the whole body in T2DM without CAD.